small intestine disorders clinical features investigations management medical education diagrams

mkdir -p /home/daytona/workspace/small-intestine-ppt && ls /home/daytona/workspa…

~/small-intestine-ppt/create_pptx.js

const pptxgen = require("pptxgenjs");
const { execSync } = require("child_process");

// Fetch images
const imageUrls = [
  "https://cdn.orris.care/cdss_images/158bc9cc39e323c81d9f0cccaa784bfbb067bab526f2241ccac5c8435bc1e400.png",
  "https://cdn.orris.care/cdss_images/d2918e8deba389a22ac8f4bbb21a6215b76958fc3eccdb92b55aa48059500ff8.png"
];

let images = [];
try {
  images = JSON.parse(execSync(
    `node /home/daytona/skills/shared/scripts/fetch_images.js "${imageUrls[0]}" "${imageUrls[1]}"`
  ).toString());
} catch(e) {
  console.log("Image fetch error:", e.message);
}

const obsImg = images[0] && !images[0].error ? images[0].base64 : null;
const stepImg = images[1] && !images[1].error ? images[1].base64 : null;

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.author = "Medical Education";
pres.title = "Disorders of Small Intestine";

// ─── Color palette ───────────────────────────────────────────────────
const C = {
  navy:    "0D2B55",   // dominant dark
  teal:    "1A7A8A",   // supporting
  accent:  "E8A020",   // warm gold accent
  light:   "EEF4F7",   // light background
  white:   "FFFFFF",
  text:    "1C2B36",
  subtext: "4A6070",
  red:     "C0392B",
  green:   "1E8449",
};

// ─── Helper: section slide ───────────────────────────────────────────
function sectionSlide(title, subtitle) {
  const sl = pres.addSlide();
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: C.navy } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 4.8, w: "100%", h: 0.8, fill: { color: C.teal } });
  sl.addShape(pres.ShapeType.rect, { x: 0.5, y: 1.8, w: 0.1, h: 2, fill: { color: C.accent } });
  sl.addText(title, { x: 0.8, y: 1.8, w: 8.5, h: 2, fontSize: 38, bold: true, color: C.white, fontFace: "Calibri" });
  if (subtitle) {
    sl.addText(subtitle, { x: 0.8, y: 3.9, w: 8.5, h: 0.7, fontSize: 18, color: C.accent, fontFace: "Calibri" });
  }
  return sl;
}

// ─── Helper: content slide ───────────────────────────────────────────
function contentSlide(title, bullets, opts = {}) {
  const sl = pres.addSlide();
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: C.light } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: 0.85, fill: { color: C.navy } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0.85, w: "100%", h: 0.06, fill: { color: C.accent } });
  sl.addText(title, { x: 0.2, y: 0.08, w: 9.6, h: 0.7, fontSize: 22, bold: true, color: C.white, fontFace: "Calibri", valign: "middle" });

  const bx = opts.imgRight ? 0.3 : 0.3;
  const bw = opts.imgRight ? 5.7 : 9.4;
  const by = 1.05;
  const bh = opts.imgRight ? 4.3 : 4.3;

  const items = bullets.map((b, i) => {
    if (typeof b === "object") {
      const arr = [];
      arr.push({ text: b.head, options: { bullet: { type: "bullet" }, bold: true, color: C.navy, fontSize: b.size || 15, breakLine: true, fontFace: "Calibri" } });
      if (b.sub) {
        b.sub.forEach((s, si) => {
          arr.push({ text: "  " + s, options: { bullet: false, color: C.text, fontSize: (b.size || 15) - 1, breakLine: si < b.sub.length - 1, fontFace: "Calibri" } });
        });
      }
      return arr;
    }
    return { text: b, options: { bullet: { type: "bullet" }, color: C.text, fontSize: 14, breakLine: i < bullets.length - 1, fontFace: "Calibri" } };
  }).flat();

  sl.addText(items, { x: bx, y: by, w: bw, h: bh, valign: "top" });

  if (opts.imgRight && opts.imgData) {
    sl.addImage({ data: opts.imgData, x: 6.15, y: 1.05, w: 3.55, h: 4.3 });
  }
  return sl;
}

// ─── Helper: two-column slide ─────────────────────────────────────────
function twoColSlide(title, leftItems, rightItems, leftTitle, rightTitle) {
  const sl = pres.addSlide();
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: C.light } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: 0.85, fill: { color: C.navy } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0.85, w: "100%", h: 0.06, fill: { color: C.accent } });
  sl.addText(title, { x: 0.2, y: 0.08, w: 9.6, h: 0.7, fontSize: 22, bold: true, color: C.white, fontFace: "Calibri", valign: "middle" });

  // Left column
  sl.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.0, w: 4.4, h: 4.5, fill: { color: C.white }, line: { color: C.teal, width: 1.5 } });
  sl.addText(leftTitle, { x: 0.3, y: 1.0, w: 4.4, h: 0.45, fontSize: 14, bold: true, color: C.white, fontFace: "Calibri", align: "center", fill: { color: C.teal } });
  sl.addText(leftItems.map((t, i) => ({ text: t, options: { bullet: { type: "bullet" }, color: C.text, fontSize: 13, breakLine: i < leftItems.length - 1, fontFace: "Calibri" } })),
    { x: 0.4, y: 1.5, w: 4.2, h: 3.9, valign: "top" });

  // Right column
  sl.addShape(pres.ShapeType.rect, { x: 5.3, y: 1.0, w: 4.4, h: 4.5, fill: { color: C.white }, line: { color: C.accent, width: 1.5 } });
  sl.addText(rightTitle, { x: 5.3, y: 1.0, w: 4.4, h: 0.45, fontSize: 14, bold: true, color: C.white, fontFace: "Calibri", align: "center", fill: { color: C.accent } });
  sl.addText(rightItems.map((t, i) => ({ text: t, options: { bullet: { type: "bullet" }, color: C.text, fontSize: 13, breakLine: i < rightItems.length - 1, fontFace: "Calibri" } })),
    { x: 5.4, y: 1.5, w: 4.2, h: 3.9, valign: "top" });

  return sl;
}

// ─────────────────────────────────────────────────────────────────────
// SLIDE 1 – TITLE
// ─────────────────────────────────────────────────────────────────────
{
  const sl = pres.addSlide();
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: C.navy } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 4.6, w: "100%", h: 1.025, fill: { color: C.teal } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 2.1, w: "100%", h: 0.08, fill: { color: C.accent } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 2.18, w: "100%", h: 0.02, fill: { color: C.white } });
  sl.addText("Disorders of the Small Intestine", {
    x: 0.5, y: 0.3, w: 9, h: 1.8, fontSize: 40, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle"
  });
  sl.addText("Clinical Features  •  Investigations  •  Management", {
    x: 0.5, y: 2.3, w: 9, h: 0.7, fontSize: 20, color: C.accent, fontFace: "Calibri", align: "center"
  });
  sl.addText("Including Short Gut Syndrome", {
    x: 0.5, y: 3.05, w: 9, h: 0.55, fontSize: 18, color: C.light, fontFace: "Calibri", align: "center"
  });
  sl.addText("For MBBS Students  |  General Surgery & Medicine", {
    x: 0.5, y: 4.7, w: 9, h: 0.7, fontSize: 15, color: C.white, fontFace: "Calibri", align: "center", valign: "middle"
  });
}

// ─────────────────────────────────────────────────────────────────────
// SLIDE 2 – OVERVIEW / ANATOMY
// ─────────────────────────────────────────────────────────────────────
contentSlide("Anatomy & Overview of Small Intestine", [
  { head: "Three segments: Duodenum | Jejunum | Ileum", sub: ["Total length: 6–7 m in vivo (3 m contracted)", "Duodenum: 25 cm, retroperitoneal, C-shaped"] },
  { head: "Functions", sub: ["Digestion and absorption of nutrients, water, electrolytes", "Immune surveillance (Peyer's patches, IgA secretion)", "Endocrine functions (GIP, CCK, secretin, motilin)"] },
  { head: "Ileum — unique absorptive sites", sub: ["Vitamin B12 (intrinsic factor complex)", "Bile salts (enterohepatic circulation)", "Fat-soluble vitamins A, D, E, K"] },
  { head: "Key disorders covered in this presentation", sub: ["Crohn's disease | Celiac disease | Tropical sprue", "Intestinal obstruction | Intussusception", "Short gut syndrome | SIBO | Intestinal tumors"] },
]);

// ─────────────────────────────────────────────────────────────────────
// SLIDE 3 – SECTION: INFLAMMATORY DISORDERS
// ─────────────────────────────────────────────────────────────────────
sectionSlide("1. Inflammatory Disorders", "Crohn's Disease  •  Celiac Disease  •  Tropical Sprue");

// ─────────────────────────────────────────────────────────────────────
// SLIDE 4 – CROHN'S DISEASE: CLINICAL FEATURES
// ─────────────────────────────────────────────────────────────────────
contentSlide("Crohn's Disease – Clinical Features", [
  { head: "Definition", sub: ["Transmural, granulomatous, skip-lesion inflammation — anywhere from mouth to anus", "Most common in terminal ileum (ileitis) and ileocaecal region"] },
  { head: "Symptoms (small intestine involvement)", sub: ["Abdominal pain: postprandial, crampy (partial obstruction) in 90%", "Diarrhoea (non-bloody in SI disease), weight loss, anorexia", "Palpable RLQ mass (thickened bowel / abscess / phlegmon)"] },
  { head: "Complications", sub: ["Strictures → bowel obstruction; Fistulas (enteroenteric, enterovesical, enterovaginal)", "Abscess formation; Perianal disease (fissures, fistulas, skin tags) in ~40%"] },
  { head: "Extraintestinal manifestations", sub: ["Joints: ankylosing spondylitis, sacroiliitis, seronegative polyarthritis", "Skin: erythema nodosum, pyoderma gangrenosum", "Eyes: uveitis, episcleritis; Liver: primary sclerosing cholangitis (rare)"] },
]);

// ─────────────────────────────────────────────────────────────────────
// SLIDE 5 – CROHN'S DISEASE: INVESTIGATIONS & MANAGEMENT
// ─────────────────────────────────────────────────────────────────────
twoColSlide("Crohn's Disease – Investigations & Management",
  ["Bloods: FBC (anaemia), ESR/CRP, albumin (low)", "Stool: culture, C. diff toxin, faecal calprotectin ↑↑", "Endoscopy: ileoscopy — cobblestone mucosa, skip lesions, deep ulcers", "CT/MRI enterography: wall thickening, creeping fat, fistulas", "Barium follow-through: string sign of Kantor (stricture)", "Histology: transmural inflammation, non-caseating granulomas"],
  ["5-ASA (mild), corticosteroids (moderate flare)", "Immunomodulators: azathioprine, 6-MP (maintenance)", "Biologics: anti-TNF (infliximab, adalimumab)", "Surgery: resection for obstruction, fistulas, abscess (conservative — preserve bowel)", "Nutritional support: elemental diet, TPN if severe", "Monitor: colonoscopy for dysplasia after 10 yrs"],
  "Investigations", "Management"
);

// ─────────────────────────────────────────────────────────────────────
// SLIDE 6 – CELIAC DISEASE
// ─────────────────────────────────────────────────────────────────────
contentSlide("Celiac Disease (Gluten-Sensitive Enteropathy)", [
  { head: "Pathophysiology", sub: ["Autoimmune enteropathy triggered by gluten (wheat/barley/rye) in genetically predisposed (HLA-DQ2/DQ8)", "IgA anti-gliadin, anti-endomysial (EMA), anti-tTG antibodies → villous atrophy"] },
  { head: "Clinical Features", sub: ["Classic: diarrhoea, steatorrhoea, bloating, weight loss, failure to thrive (children)", "Atypical: iron-deficiency anaemia, osteoporosis, dermatitis herpetiformis, infertility", "Silent: asymptomatic, found on screening"] },
  { head: "Investigations", sub: ["Serology: anti-tTG IgA (sensitivity ~95%), IgA level (exclude deficiency)", "Endoscopy + duodenal biopsy: villous atrophy, crypt hyperplasia, intraepithelial lymphocytes (Marsh III)", "HLA typing (DQ2/DQ8 — high NPV to exclude)"] },
  { head: "Management", sub: ["Strict lifelong gluten-free diet — cornerstone of treatment", "Nutritional supplementation: iron, folate, B12, calcium, vitamin D", "Refractory celiac: corticosteroids, azathioprine"] },
]);

// ─────────────────────────────────────────────────────────────────────
// SLIDE 7 – TROPICAL SPRUE
// ─────────────────────────────────────────────────────────────────────
contentSlide("Tropical Sprue", [
  { head: "Definition", sub: ["Acquired malabsorption disorder in residents of / visitors to tropical regions", "Likely caused by bacterial overgrowth (enterotoxigenic organisms + folate depletion)"] },
  { head: "Clinical Features", sub: ["Diarrhoea (3–10 loose stools/day), steatorrhoea, weight loss", "Macrocytic / megaloblastic anaemia (folate/B12 deficiency)", "Glossitis, oedema, wasting"] },
  { head: "Investigations", sub: ["Blood: megaloblastic anaemia, low serum folate & B12", "D-xylose absorption test: reduced absorption (villous atrophy)", "Biopsy: partial villous atrophy (less severe than celiac), not IgA mediated", "Stool: fat globules, no parasites"] },
  { head: "Management", sub: ["Folic acid + B12 replacement (2–3 months)", "Tetracycline 250 mg QID for 3–6 months (eradicates bacterial overgrowth)", "Response expected within weeks; most achieve full remission"] },
]);

// ─────────────────────────────────────────────────────────────────────
// SLIDE 8 – SECTION: OBSTRUCTIVE DISORDERS
// ─────────────────────────────────────────────────────────────────────
sectionSlide("2. Obstructive Disorders", "Intestinal Obstruction  •  Intussusception  •  Volvulus");

// ─────────────────────────────────────────────────────────────────────
// SLIDE 9 – INTESTINAL OBSTRUCTION (with image)
// ─────────────────────────────────────────────────────────────────────
{
  const sl = pres.addSlide();
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: C.light } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: 0.85, fill: { color: C.navy } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0.85, w: "100%", h: 0.06, fill: { color: C.accent } });
  sl.addText("Intestinal Obstruction – Small Bowel", { x: 0.2, y: 0.08, w: 9.6, h: 0.7, fontSize: 22, bold: true, color: C.white, fontFace: "Calibri", valign: "middle" });

  const bullets = [
    { head: "Causes (80%: hernias, adhesions, intussusception, volvulus)", sub: ["Adhesions (MC in adults — post-surgical)", "Hernias (inguinal, femoral, incisional)", "Neoplasms; Crohn's strictures; Gallstone ileus"] },
    { head: "Clinical Features", sub: ["Colicky abdominal pain, vomiting (bilious early), abdominal distension", "Absolute constipation (no flatus/stool) in complete obstruction", "High-pitched tinkling bowel sounds early; silent in strangulation"] },
    { head: "Investigations", sub: ["X-ray abdomen: dilated loops, air-fluid levels, no gas in colon", "CT abdomen: transition point, identify cause, detect strangulation", "USS: dilated bowel, peristalsis assessment"] },
    { head: "Management", sub: ["Conservative: NBM, NG tube (decompression), IV fluids, electrolyte correction", "Surgery: if strangulation, perforation, or failed conservative — resection/adhesiolysis"] },
  ];

  const items = bullets.map(b => {
    const arr = [];
    arr.push({ text: b.head, options: { bullet: { type: "bullet" }, bold: true, color: C.navy, fontSize: 14, breakLine: true, fontFace: "Calibri" } });
    b.sub.forEach((s, si) => {
      arr.push({ text: "  " + s, options: { bullet: false, color: C.text, fontSize: 13, breakLine: true, fontFace: "Calibri" } });
    });
    return arr;
  }).flat();
  // remove last breakLine
  if (items.length > 0) items[items.length - 1].options.breakLine = false;
  sl.addText(items, { x: 0.3, y: 1.05, w: 5.7, h: 4.4, valign: "top" });

  if (obsImg) {
    sl.addImage({ data: obsImg, x: 6.2, y: 1.1, w: 3.5, h: 3.5 });
    sl.addText("FIG: Four major causes of intestinal obstruction\n(Robbins & Kumar Basic Pathology)", {
      x: 6.1, y: 4.6, w: 3.7, h: 0.7, fontSize: 9, color: C.subtext, fontFace: "Calibri", italic: true, align: "center"
    });
  }
}

// ─────────────────────────────────────────────────────────────────────
// SLIDE 10 – INTUSSUSCEPTION
// ─────────────────────────────────────────────────────────────────────
contentSlide("Intussusception", [
  { head: "Definition", sub: ["Telescoping of a proximal bowel segment (intussusceptum) into the distal segment (intussuscipiens)", "MC cause of intestinal obstruction in children < 2 years"] },
  { head: "Types", sub: ["Idiopathic (infants — reactive Peyer's patch hyperplasia; rotavirus association)", "Secondary to lead point: Meckel's diverticulum, polyp, lymphoma (older children/adults)"] },
  { head: "Clinical Features", sub: ["Classic triad: colicky abdominal pain, redcurrant jelly stools, palpable sausage-shaped mass (RUQ)", "Vomiting, lethargy, intermittent pain episodes", "Dance sign: emptiness in RIF (mass moved toward right)"] },
  { head: "Investigations & Management", sub: ["USS: target sign / doughnut sign (concentric rings)", "Contrast/air enema: diagnostic AND therapeutic (80–90% success in children)", "Surgery if peritonitis, failed reduction, or lead point identified (adults)"] },
]);

// ─────────────────────────────────────────────────────────────────────
// SLIDE 11 – SECTION: NUTRITIONAL/ABSORPTIVE DISORDERS
// ─────────────────────────────────────────────────────────────────────
sectionSlide("3. Malabsorption & Nutritional Disorders", "Short Gut Syndrome  •  SIBO  •  Whipple's Disease");

// ─────────────────────────────────────────────────────────────────────
// SLIDE 12 – SHORT GUT SYNDROME (PATHOPHYSIOLOGY)
// ─────────────────────────────────────────────────────────────────────
contentSlide("Short Gut Syndrome (SGS) – Pathophysiology", [
  { head: "Definition", sub: ["Clinical state where residual intestine cannot maintain adequate absorption of nutrients, fluids, and electrolytes", "Usually follows massive small bowel resection (>50% loss)"] },
  { head: "Common causes", sub: ["Adults: Crohn's disease (most common), mesenteric ischaemia/infarction, trauma, radiation enteritis", "Neonates/Paediatric: NEC (35%), intestinal atresia (25%), gastroschisis (18%), midgut volvulus (14%)"] },
  { head: "Key determinants of outcome", sub: ["Residual bowel length: ≥35–40 cm → 50% chance of weaning off TPN", "Each additional cm increases enteral autonomy rate by 4%", "Presence of ileocaecal valve (acts as surrogate for terminal ileum)", "Colon in continuity: essential for water/electrolyte salvage"] },
  { head: "Intestinal adaptation", sub: ["Physiologic process post-resection: villous hyperplasia, crypt deepening, bowel dilation", "Takes weeks to months; enhanced by enteral feeding and growth factors (GLP-2/teduglutide)"] },
]);

// ─────────────────────────────────────────────────────────────────────
// SLIDE 13 – SHORT GUT SYNDROME: CLINICAL FEATURES & INVESTIGATIONS
// ─────────────────────────────────────────────────────────────────────
contentSlide("Short Gut Syndrome – Clinical Features & Investigations", [
  { head: "Clinical features", sub: ["High-volume diarrhoea / steatorrhoea, dehydration, electrolyte imbalances", "Weight loss, malnutrition, fatigue", "Fat-soluble vitamin deficiencies (A, D, E, K) → coagulopathy, metabolic bone disease", "Vitamin B12 deficiency (ileal loss) → macrocytic anaemia", "D-lactic acidosis (colonic bacterial fermentation) → confusion, ataxia"] },
  { head: "Complications of TPN dependence", sub: ["Catheter-related bloodstream infections (CRBSI)", "TPN-associated liver disease / cholestasis → cirrhosis", "Gallstones (biliary stasis, 100% incidence in severe cases on long-term TPN)", "Metabolic bone disease"] },
  { head: "Investigations", sub: ["Bloods: FBC, LFTs, renal function, electrolytes, vitamins (B12, folate, D, A, E, K)", "Serum zinc, selenium, magnesium, phosphate", "Bone densitometry (DEXA) for osteoporosis; USS liver/gallbladder", "72-hour faecal fat collection (confirms steatorrhoea)", "Barium/CT enterography to assess residual bowel length and anatomy"] },
]);

// ─────────────────────────────────────────────────────────────────────
// SLIDE 14 – SHORT GUT SYNDROME: MANAGEMENT (with image)
// ─────────────────────────────────────────────────────────────────────
{
  const sl = pres.addSlide();
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: C.light } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: 0.85, fill: { color: C.navy } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0.85, w: "100%", h: 0.06, fill: { color: C.accent } });
  sl.addText("Short Gut Syndrome – Principles of Management", { x: 0.2, y: 0.08, w: 9.6, h: 0.7, fontSize: 22, bold: true, color: C.white, fontFace: "Calibri", valign: "middle" });

  // Phases boxes
  const phases = [
    { label: "Phase 1\n(0–3 wks)", text: "Total parenteral nutrition (TPN)\nIV fluid & electrolyte replacement\nAntidiarrhoeals (loperamide, codeine)", col: C.red },
    { label: "Phase 2\n(3 wks–1 yr)", text: "Gradual introduction of oral/enteral feeds\nTPN weaned as tolerance improves\nTrophic feeds stimulate adaptation", col: C.teal },
    { label: "Phase 3\n(>1 yr)", text: "Enteral autonomy if bowel adapts\nTeduglutide (GLP-2 analogue) to enhance adaptation\nProkinetics / antisecretory agents", col: C.green },
  ];

  phases.forEach((p, i) => {
    const x = 0.3 + i * 3.2;
    sl.addShape(pres.ShapeType.rect, { x, y: 1.0, w: 3.0, h: 0.5, fill: { color: p.col } });
    sl.addText(p.label, { x, y: 1.0, w: 3.0, h: 0.5, fontSize: 12, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle" });
    sl.addShape(pres.ShapeType.rect, { x, y: 1.5, w: 3.0, h: 1.5, fill: { color: C.white }, line: { color: p.col, width: 1.5 } });
    sl.addText(p.text, { x: x + 0.08, y: 1.55, w: 2.84, h: 1.4, fontSize: 11, color: C.text, fontFace: "Calibri", valign: "top" });
  });

  // Surgical options
  sl.addText("Surgical Options for Dilated Residual Bowel:", { x: 0.3, y: 3.15, w: 5.5, h: 0.4, fontSize: 14, bold: true, color: C.navy, fontFace: "Calibri" });
  const surgBullets = [
    "Bianchi (LILT): Longitudinal intestinal lengthening — splits bowel into 2 parallel segments, doubles length",
    "STEP (Serial Transverse Enteroplasty): transverse stapling creates zigzag, narrows & lengthens bowel",
    "Small bowel transplantation: last resort for irreversible intestinal failure + TPN complications",
    "Cholecystectomy: prophylactic in long-term TPN patients (100% gallstone risk)",
  ];
  sl.addText(surgBullets.map((t, i) => ({ text: t, options: { bullet: { type: "bullet" }, color: C.text, fontSize: 12, breakLine: i < surgBullets.length - 1, fontFace: "Calibri" } })),
    { x: 0.3, y: 3.55, w: 5.6, h: 1.9, valign: "top" });

  if (stepImg) {
    sl.addImage({ data: stepImg, x: 6.15, y: 3.1, w: 3.55, h: 2.35 });
    sl.addText("FIG: Bianchi (A) & STEP (B) bowel-lengthening procedures\n(Sabiston Textbook of Surgery)", {
      x: 6.05, y: 5.45, w: 3.7, h: 0.4, fontSize: 9, color: C.subtext, fontFace: "Calibri", italic: true, align: "center"
    });
  }
}

// ─────────────────────────────────────────────────────────────────────
// SLIDE 15 – SIBO (Small Intestinal Bacterial Overgrowth)
// ─────────────────────────────────────────────────────────────────────
contentSlide("Small Intestinal Bacterial Overgrowth (SIBO)", [
  { head: "Definition", sub: [">10^5 CFU/mL organisms in proximal small intestine", "Normally kept low by gastric acid, peristalsis, IgA, ileocaecal valve"] },
  { head: "Causes / Predisposing factors", sub: ["Hypomotility: scleroderma, diabetic autonomic neuropathy, post-surgical (Roux-en-Y, blind loops)", "Anatomical: strictures, diverticula, fistulas, SGS", "Achlorhydria (PPI use, gastric surgery); Immunodeficiency"] },
  { head: "Clinical Features", sub: ["Bloating, abdominal discomfort, diarrhoea, steatorrhoea", "Fat-soluble vitamin and B12 deficiency", "D-lactic acidosis (short bowel + colon in continuity)"] },
  { head: "Investigations & Management", sub: ["Hydrogen/methane breath test (lactulose or glucose) — elevated H2/CH4 at <90 min", "Gold standard: jejunal aspirate & culture (>10^5 CFU/mL)", "Rifaximin 550 mg TDS × 14 days (first line); also metronidazole, ciprofloxacin", "Address underlying cause; rotating antibiotics for recurrent SIBO"] },
]);

// ─────────────────────────────────────────────────────────────────────
// SLIDE 16 – SECTION: TUMOURS
// ─────────────────────────────────────────────────────────────────────
sectionSlide("4. Tumours of the Small Intestine", "Benign  •  Malignant  •  Carcinoid / NET");

// ─────────────────────────────────────────────────────────────────────
// SLIDE 17 – SMALL BOWEL TUMOURS
// ─────────────────────────────────────────────────────────────────────
twoColSlide("Small Bowel Tumours – Overview",
  ["Adenoma (tubular/villous — duodenum)", "Leiomyoma / GIST (stromal)", "Lipoma (submucosal)", "Brunner's gland hyperplasia", "Peutz-Jeghers hamartomas (hamartomatous polyps)", "Haemangioma (cause of GI bleeding)"],
  ["Adenocarcinoma (most common malignant — duodenum/jejunum)", "Carcinoid / NET: ileum MC site; secretes serotonin — carcinoid syndrome", "Lymphoma (MALT type; increased risk in celiac)", "GIST (KIT/PDGFRA mutation; CD117+)", "Metastases (melanoma, lung, breast)"],
  "Benign Tumours", "Malignant Tumours"
);

// ─────────────────────────────────────────────────────────────────────
// SLIDE 18 – CARCINOID / NET & INVESTIGATIONS
// ─────────────────────────────────────────────────────────────────────
contentSlide("Carcinoid Syndrome & Small Bowel Tumour Investigations", [
  { head: "Carcinoid Syndrome (when liver metastases present)", sub: ["Episodic flushing, secretory diarrhoea, bronchospasm, right-sided valvular disease (tricuspid)", "Elevated urinary 5-HIAA (>25 mg/24h)", "Serum chromogranin A (tumour marker)"] },
  { head: "Investigations for small bowel tumours", sub: ["CT/MRI enterography: mass, lymphadenopathy, liver metastases", "Capsule endoscopy: best for mid-gut tumours (no biopsy)", "Double-balloon enteroscopy: biopsy + therapy", "Octreotide scan (Ga-68 DOTANOC PET/CT for NETs)", "Upper GI endoscopy + biopsy for duodenal tumours"] },
  { head: "Management principles", sub: ["Surgical resection (curative for localised disease)", "Somatostatin analogues (octreotide/lanreotide) for carcinoid syndrome control", "PRRT (Peptide Receptor Radionuclide Therapy) for metastatic NETs", "Imatinib/sunitinib for GIST; R-CHOP for lymphoma"] },
]);

// ─────────────────────────────────────────────────────────────────────
// SLIDE 19 – SUMMARY TABLE
// ─────────────────────────────────────────────────────────────────────
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    ["Crohn's disease", "Transmural, skip lesions, RLQ pain", "CT enterography, ileoscopy", "5-ASA → steroids → biologics"],
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    ["Intestinal obstruction", "Colicky pain, distension, vomiting", "AXR air-fluid levels, CT", "NBM + NGT; surgery if needed"],
    ["Intussusception", "Redcurrant jelly stool, RUQ mass", "USS target sign", "Air/contrast enema; surgery"],
    ["Short gut syndrome", "Diarrhoea, malnutrition, TPN dependence", "Serum vitamins, CT enterography", "TPN → enteral feeds; STEP/Bianchi"],
    ["SIBO", "Bloating, B12 deficiency, H2 breath test +", "Breath test / jejunal aspirate", "Rifaximin × 14 days"],
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// ─────────────────────────────────────────────────────────────────────
// SLIDE 20 – THANK YOU / KEY TAKEAWAYS
// ─────────────────────────────────────────────────────────────────────
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    "Crohn's: transmural skip lesions — think complications (stricture, fistula, abscess)",
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  sl.addText("References: Sabiston Surgery 21e  |  Robbins Basic Pathology 11e  |  Sleisenger & Fordtran GI  |  Maingot's Abdominal Operations", {
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~/small-intestine-ppt/create_pptx.js

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/small-intestine-ppt/create_pptx.js'

cat > /home/daytona/workspace/small-intestine-ppt/create_pptx.js << 'JSEOF' cons…

cd /home/daytona/workspace/small-intestine-ppt && node create_pptx.js

cd /home/daytona/workspace/small-intestine-ppt && curl -s -o obs_img.png "https:…

cd /home/daytona/workspace/small-intestine-ppt && sed -i 's|// Fetch images.*||'…

cd /home/daytona/workspace/small-intestine-ppt && node -e " const pptxgen = requ…

cat > /home/daytona/workspace/small-intestine-ppt/build_final.js << 'JSEOF' cons…

cd /home/daytona/workspace/small-intestine-ppt && node build_final.js && ls -lh …